Stepping Up to Understand Movement Challenges in Bilateral Cerebral Palsy

Goyal, Vatsala

doi:https://doi.org/10.21985/n2-5d80-yd26

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Stepping Up to Understand Movement Challenges in Bilateral Cerebral Palsy

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Stairs and curbs often present as an exhausting environmental barrier for individuals with bilateral cerebral palsy (CP) due to their lower limb motor impairments. Indeed, performance in stair-climbing in this population has a higher correlation with disruption of mobility than walking. Community members affected by CP consider impaired mobility a high priority research area, especially given its link to serious comorbidities such as cardiovascular disease and chronic pain. Therefore, quantification of movement strategies during a step-up task in children and adolescents can offer insight into the specific impairments responsible for making stairs a barrier throughout life in CP. The results of this dissertation serve to inform intervention strategies for improving mobility and can offer a window into descending pathways influencing movement for people with bilateral CP. We first characterized the effect of load modulation on the biomechanics of a step-up task in young people without bilateral CP to build an age-appropriate model of task completion. We then compared this response to the biomechanical patterns of young individuals with bilateral CP during a step-up task with and without load modulation. Outcome measures, including frontal and sagittal plane moments in the hip, knee, and ankle, were quantified using a motion capture system in combination with force plates. Participants with bilateral CP performed similarly to their peers without bilateral CP during the step-up trials, which included increasing their extensor support moments with load but not their hip abduction moments. While participants without bilateral CP primarily used their knee and ankle to drive support moments, participants with CP increasingly depended on their hip across all load levels. Quantification of these movement strategies is a critical first step in deepening our understanding of lower limb motor impairments and the neural mechanisms behind reduced mobility in bilateral CP.

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